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Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-021-00369-w.

RESUME Les publications sur la tomographie par emission de positon (TEP) dans les cancers digestifs sont peu nombreuses, en dehors des recidives des cancers colo-rectaux. Ce travail, prospectif, a porte sur 120 TEP realisees chez des patients qui avaient un cancer de l’appareil digestif. La TEP a ete demandee dans vingt-huit cancers cardio-oesophagiens pour chercher des metastases viscerales ; la sensibilite a ete de 67 % et la specificite de 100 %. Dans vingt-deux cancers du pancreas, pour le diagnostic de la tumeur primitive la sensibilite a ete de 64 % ; dans le diagnostic de metastases, elle etait de 70 % et la specificite de 83 %. Dans soixante-dix cancers colo-rectaux recidives ou metastases, la TEP, pour le diagnostic de carcinose peritoneale, etait superieure au scanner, mais sa sensibilite n’etait que de 58 %. Pour le diagnostic de metastases hepatiques, sa valeur etait similaire a celle du scanner ou de l’echographie. Enfin, pour le diagnostic de metastases pulmonaires, elle etait similaire au scanner. La TEP a eu une utilite decisionnelle, dans les cancers cardiooesophagiens chez deux malades sur vingt-huit (7 %) ; dans les cancers du pancreas chez un malade sur vingt-deux (5 %) ; dans les cancers colo-rectaux, la TEP n’a pas modifie la decision therapeutique dans quarante-huit cas (67 %). Si l’on avait tenu compte de ses resultats, elle aurait fait modifier cette decision dans vingt-deux cas (33 %), onze fois a bon escient, et onze fois a tort. Dans l’etat actuel de la technique, ces resultats sont decevants. Ils montrent la necessite d’apprecier les examens complementaires en terme d’utilite decisionnelle et de couts, plutot que de les multiplier aveuglement.

We evaluated positon emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in 120 patients with intestinal malignancies, focusing on its diagnostic yield and influence on the surgical strategy. PET had a sensitivity of 67% and a specificity of 100% for metastases in 28 patients with cardio-esophageal carcinoma. PET detected 64% of 22 primary pancreatic carcinomas, and had a sensitivity of 70% and a specificity of 83% for metastases. In two cases, PET showed false-positive signs of peritoneal metastasis (not found at laparotomy). Among 70 patients with recurrent or metastatic colorectal carcinoma, eight had signs of local recurrence of rectal carcinoma treated by abdominoperineal resection; PET gave four true-positive, one false-negative, and three false-positive results. PET was better than computed tomography (CT) for the diagnosis of peritoneal metastasis, but its sensitivity was only 58%. The diagnostic value of PET for hepatic metastases (87%) was similar to that of CT (77%) and sonography (87%). The diagnostic sensitivity of PET for pulmonary metastases (82%) was similar to that of CT (84%). PET modified the surgical strategy in two (7%) of 28 patients with cardio-esophageal carcinoma, one (5%) of 22 patients with pancreatic carcinoma, and 22 (33%) of 70 patients with colorectal carcinoma (appropriately in 11 cases, inappropriately in 11 cases). These disappointing results suggest that PET must be thoroughly evaluated in this setting before being widely adopted.

To evaluate positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) for characterizing and initial staging of pancreatic tumors and to determine its impact on therapeutic strategy.This study included 24 patients with pancreatic tumor who underwent PET before treatment. Twenty-two patients had a malignant tumor and two had a benign tumor. The PET scan was performed after intravenous injection of FDG with a gamma camera. PET findings were compared with histology of the pancreatic tumor (n=24), liver metastases (n=5), peritoneal metastases (n=5), and lymph node metastases (n=5). Absence of metastasis or lymph node involvement was determined by surgery or by CT scan, ultrasonography, magnetic resonance imaging and at least two months follow-up.The sensitivity of the PET scans to identify pancreatic carcinoma was 64% (95% confidence interval 44-84%). PET scans could not be interpreted for lymph node involvement adjacent to the tumor. For liver metastases, the PET scan was positive in 3 out of 5 patients. For peritoneal metastases, the PET scan was positive in 4 out of 5 patients but was doubtful in one. There were two false positives. Among the 4 cystic tumors, the PET scan was positive for 2 malignant tumors and negative for 2 benign tumors. Surgical strategy was modified in only one of the 24 patients on the basis of PET findings.The sensitivity of PET for the diagnosis of primary malignant pancreatic tumor was found to be low. The contribution of FDG-PET to the surgical decision appears to be limited to the detection of metastases or lymph node involvement distant from the tumor, contraindicating surgery. Nevertheless, the sensitivity of FDG-PET is lower than that of laparoscopy for peritoneal metastases. Indications for PET should be included in an evaluation of therapeutic decision making and cost analysis.